Blue Cross Blue Shield (BCBS) is a federation of 34 independent health insurance companies that have in the recent past undergone much legal trouble with huge settlements. The settlements arose from allegations of violation of antitrust law, including suppressing competition and increased prices of insurance. The article discusses the details of these settlements, eligibility for potential claimants, and the proper procedures for determining qualification for payments.
Settlements Overview
Subscriber Settlement: $2.67 Billion
In 2020, BCBS settled for $2.67 billion to end a 2013 class action that accused BCBS of engaging in anticompetitive behavior among its member companies thereby raising the price of insurance. It was estimated that about six million subscribers will benefit from this settlement. Persons covered by certain BCBS health insurance or administrative services plans between February 2008 and October 2020 were eligible for the award. The deadline for filing claims was in November 2021, with expected compensation averaging about $333 per claim.
Provider Settlement: $2.8 Billion
In October 2024, BCBS entered into a $2.8 billion settlement of the antitrust claims filed by hospital systems, physicians, and other health providers. The plaintiff’s allegations were that BCBS and its affiliates conspired to divide the United States into exclusive regions in violation of the antitrust laws, causing insurance costs to go up and reimbursement rates to go down. One of the largest settlements in healthcare antitrust history included also the establishment of a cloud-based platform devoted to transparency and efficiency in claims processing.
Eligibility Criteria for the Subscriber Settlement
To receive payment from the $2.67 billion subscriber settlement, the claims made by persons or entities had to fit these criteria below:
- Fully Insured Class Members are defined as individuals and insured groups under any Blue-Branded Commercial Health Benefit Products from February 7, 2008, to October 16, 2020. Dependents, beneficiaries, and non-employees were ineligible for payment.
- Self-Funded Class Members refer to self-funded accounts under Blue Cross indemnity plan from September 1, 2015, to October 16, 2020. Dependents, beneficiaries, and non-employees were again excluded from eligibility.
- Please note: The filing deadline for this settlement claim was November 5, 2021. Therefore, no further claims are being accepted. Eligible claimants who filed claims before the deadline are now receiving claim determination notices on a rolling basis.
- To qualify for the Provider Settlement, health-care providers have a claim for compensation under the $2.8 billion settlement if they satisfy the following criteria:
- Class Members include all health-care providers in the United States delivering any service, supply, or equipment to patients covered by or beneficiaries of any plan administered by a Blue Plan from the class period of July 24, 2008, to October 4, 2024.
- Exclusions apply to providers who are employed or owned by defendants’ affiliates or the government or to those rendering services to Medicaid or Medicare or any other federal health benefit program exclusively. Providers that opted out are not eligible, nor are those providing selected services such as prescribed drugs or durable medical equipment on their own.
- The settlement is pending final approval, and a hearing is set for July 16, 2025. Eligible providers would then be directed on how to file a claim for compensation.
Steps to Determine Eligibility and Claim Process
- Determine Coverage During the Period by verifying whether you or your organization maintained any BCBS coverage during the class periods that correspond to subscribers from February 7, 2008, to October 16, 2020, and providers from July 24, 2008, to October 4, 2024.
- Review Settlement Information. Check the relevant settlement websites or contact the settlement administrator for details of every settlement, where information on eligibility and claim submission deadlines will be provided.
- File a Claim if you qualify. The claim submission deadline for the subscriber settlement is closed. The provider settlement will allow claims only after the final approval. Once that is granted, collect all documentation necessary to support your claim.
- Keep an eye on communications. Keep an eye on the settlements’ official communications. Claim determination notices are presently being sent for the subscriber settlement. The provider settlement will receive updates after final approval hearings.
Conclusion
The Blue Cross Blue Shield settlements mark some important moments in the health insurance industry’s antitrust issues. Although the subscriber settlement is winding down, the healthcare providers should keep an ear out for the final approval of the provider settlement so they can collect any amounts due to them.
